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Pick your pace

In its final rule, CMS made changes to the roll-out of MACRA. CMS had previously proposed that physicians’ Medicare payment would be positively or negatively adjusted based on performance and utilization data for the entire year of 2017.

The final rule creates a more flexible schema wherein physicians who submit ANY data in 2017 can avoid a negative adjustment. Physicians who submit more data will get a higher payment.

The Centers for Medicare and Medicaid Services (CMS), announced changes to the roll-out of MACRA’s Quality Payment Program on September 8 and confirmed those changes in the final rule. CMS creates a more flexible schema wherein physicians who submit ANY data in 2017 can avoid a negative adjustment to their payment. Physicians who submit more data will get a positive payment adjustment. Here are the options for physicians:

First Option

Test the Program: Submit a minimum amount of 2017 data (e.g., one quality measure or one improvement activity) and avoid a negative payment adjustment. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019.

Second Option

Participate for Part of the Calendar Year: Submit 90 days of 2017 data and you may receive a small positive adjustment. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment.

Third Option

Participate for the Full Calendar Year: Submit data to the program for a full 2017 calendar year and receive a bigger positive adjustment. This means your first performance period would begin on January 1, 2017. If you submit information on quality measures, how your practice uses technology and what improvement activities your practice is undertaking for the entire year, you could qualify for a bigger positive payment adjustment.

Fourth Option

Participate in an Advanced Alternative Payment Model in 2017: Instead of reporting data through the Merit-Based Incentive Payment System (MIPS) track as described in Options One, Two and Three above, the law allows you to participate in the program by joining an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3, in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a five percent incentive payment in 2019.

Fifth Option

Do Not Participate in the Quality Payment Program and Take the Payment Penalty: If you are a MIPS-eligible clinician (not eligible to participate through an Advanced Alternative Payment Model) and you do not submit any 2017 data, then you receive a negative four percent payment adjustment.

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The California Academy of Family Physicians is the only organization solely dedicated to advancing the specialty of family medicine in the state. Since 1948, CAFP has championed the cause of family physicians and their patients.

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Note:The California Academy of Family Physicians cannot answer medical questions, give referrals to specific family physicians or endorse products. Visit the American Board of Family Medicine website to find a board-certified family physician in your area.